saved millions of dollars, in preventing diabetes and in treating and if you look at the neighborhood and you say, where are the people obese, where are these types of needs? it is very much in the mission, and in that area. it would be a shame to not have this diabetic center fully staffed, with the translaters that are needed for that particular population. and all that i see is that suter is very greety. and i would ask you to please, think about what i am saying, and think about what this means to the city, if you don't prevent diabetes and you don't treat things early you are going to have a whole bunch more dollars that you will have to spend. the city is going to pay for it. >> i know that each hospital should be doing their fair share of charity and i know that the board here and the city supervisors can make that

happen. and i am also involved with the puc and to hold the people accountable. next speaker. >> (inaudible) clearing house and a member organization of the community coalition and i just want to review a couple of points. and then make a request.

this particular development offers an opportunity as you see by the nature of the development agreement which we take some responsibility and pride in saying we helped to devise, and addresses the major concerns of community groups and labor organized labor, this is a coalition of community and labor. and we are the folks who put on the table and we put on the table the mitigation around the traffic impacts in the most extraordinarily dense transit corridor geary and van ness,

one can imagine. we are the folks who argued for the continued existence and so we take the pride in that and we ask to be part of the development agreement process through a collateral agreement, and in the wisdom of your department, and in the wisdom of the city and county, no such development agreement no such collaborative agreement was made, in part because the city attorney argued that we don't do deals with people who will litigate and we are not interested in litigation, we are interested in making this

project work. thank you. >> thank you, is there additional public comment? >> okay. seeing none, public comment is closed. and we will open it to the commissioner comments and first i want to thank the health commission for making time to be here today and thank all of the members of the city staff that spoke and the public that came out and cpmc, commissioner antonini? >> thank you all for a very good presentation, and lots of interesting comments. and i think that one of the areas that there are some areas where there is concern and a lot has to do with the partial year, beginning the process. and the fact that, you know, the agreement apparently was

not finalized until november, 2013, on the paperwork, i have here, it was effective of august 10, 2013, but finally granted on november 8th, 2013, but whenever you are starting something out, there are going to be problems and my understanding is that the entry level jobs, move forward to the next year, so the shortfall must be met but you have a goal of a certain number of entry jobs that you have to do over a period of time but you may not necessarily be on track the first year. but you have to catch up, in this year but i have heard from some of the staff that they feel that they already have done that or they are close to do that. so, i think that that is important, to us to look for, next year's report. certainly, and we want to see that this one is on target and make sure that we do more things and try to enlist people, to fill these jobs. and but along some of the other comments that were made, you know, we cannot ask an employer

to hire or to retain a particular employee, this is still, a decision between the employer and the employee. and they have a goal to meet as a collective goal and that is you know, what has to be done but the individual hiring position still remain with the employer as to what they want to hire among the people, the group of which needs to be hired to fill the goal. and then there was some comment about the fact that the projected number of jobs ended up being hire than the actual number of jobs that were and try to project a particular job category within a short period of time, and it ended up that there were fewer total jobs and of course, there were fewer required, entry level jobs, that are to be given to our

target audience. and so hopefully, both categories will arise in the future. the sliper card issue and it has been brought up that the da actually has a period of two to five years for this, is that the actual language or what is the language surrounding this cliper card situation? >> sure, so the development agreement, as it relates to cliper cards is referring the tdm plan, the management plan, and that was approved by the condition of approval for the entitlements. the tdm planned very clearly, breaks transportation demand management and improvements, and into three categories, 0 to 2, five years plus. and the cliper card is very, very clearly, and the two to

five time frame and so, in order opinion there is absolutely no question about the amrikbility of the cliper card and in fact the plan itself, clearly identifies that this is really about dealing with the effects caused by new construction, and this so, we have no doubt that the two to five year time frame is the appropriate time frame for the cliper card. >> thank you. >> it sounds like criticism before it is time. >> and before the game has begun, but any way, i would suggest that on this issue, that since part of it i understand, is a requirement that the employees have, of cliper card, that if i am not mistaken and so whenever that becomes effective then, the hospital should also pay for whatever the percentages is of 50 percent of the card not to force them to get a card and then on their own, and then pay for it at a later time. it would seem to me that it would be nice if there was a

date certain on that issue because then, there will be less discussion? the future and if we could come up with something in the two to five range, hopefully closer to the two if that is possible at which time the employees will be both obliged to have cards and also the cpmc will be olijed to pay their percentage at the same time that seems like the solution in my mind for that one. >> and then on the saint lukes situation. there is a lot of comment of people having to be taken other place to have care. and that is perfectly reasonable. because i am a member of kiaser and if i want to get for radiation i had to go to south san francisco for ix weeks every morning to have radiation if i had certain type of prostate i have to go to sacramento and so you know it opens follows that a large hospital particularly all within the same city will do

the services in various campuses where it is the most efficient, however, if they are transporting them away from some site to another site they should have to pay for the ambulance rides if that is the case, i am not sure if that is true, but it is the responsibility of the facility, if the patient has presented for treatment at a certain place and is being sent somewhere else. and that will be something that if it is, you know, something that arranged ahead of time and they are asked to go to a different facility about two miles away. then that is something that is understandable. and there is a short in the medical, patients that has to be reached and we know that is a goal. and i mean, especially on a short period of time.

and you can't always force somebody to seek medical care, as a dentist, i know that a large number of people even if the services are free don't want to avoil themself to services, i am not saying that is the reason. >> it is a difficult thing and maybe one of the things that we have to do is more out reach to the target audience to make sure that they realize that they need to avail them to the service and how important it is, and so those are some of the main things, and i don't think that there is something that we are advised as a city

that we have to work between the parties involved in the future. and oh, the other final thing that i had to say is that we really need to find a partner in the tender loin to deal with this particular problem, what i am hearing is you need a non-profit or a facility in existence or can be existent in the tender loin where there is no cal pacific facility in the tender loin as yet because the hospital is only under construction because there has to be some intermediatary that the city can find. and for this particular non-profit is, and exist and so that will be the things that i see, and i think that on the whole, i agree, and i see that there are areas that need work,

and certainly i will encourage you to work on these areas, also, to address the concerns about possible language barriers within the diabetes clinic and saint lukes and make sure that there is a interpretive services, and there to make sure that any of the patients are able to communicate there. and there needs to communicate to them. >> thank you. >> thank you. and thank you everyone for your presentation and thank you for, you know, all of the city staff, and you know, like, for giving us, you know, what has been going on and, you know, there are a few things that comes to my mind, and i have a whole lot of questions because number one, you know like, this is a relatively new process.

but also at the same time i am curious, you know, why entry

level positions could be that hard to fill. those come up a lot for me because i initially started, you know, i started the transgender economic empowerment initiative that is supported by the entire city hall family, and and i know that you wish for the vocational services have been a partner with the lgbt service and i am just curious, you know like the out reach work and the effort that we are talking about, you know, like how much of that actually has been discussed with the other organization and parties that also have that focus. i am not expecting a perfect job tomorrow, but i think that, you know, there are definitely different pocket and pressure

points that we can address, and to make it better. and you know, like we have a reason to have the, the san francisco health improvement plan and we have the reason for the community health improvement plan and we have a reason for the community health master plan, and it is really to look at the gaps of the city. and you know, not just the specific hospital and how many beds here and there and it is to make sure that every single person that this, and work in this city can get the same type of quality services, no matter where they go. you know, no matter which hospital they access, and that is the part that i am not very clear either. it is not with the new beds, in saint lukes, what types of services will saint lukes be providing and how is that going to meet, you know, like some of the needs that we have in the city and how is it going to fill the gaps?

that we have identified through the health improvement plan and through the master plan. and you know, and, i can't tell you how to hire people. but it is a little bit concerning to hear that some bilingual staff are let go and that, the questions becomes you know, like what is it like? you know? for a patient to navigate through the system? i totally understand that sometimes you have to have specialties and you know, like services in one hospital, and because we want everybody to get the best care. and live in the excelcier that my late grandfather benefited from saint lukes because that is the hospital that he actually went to when an medical emergency came up. the last time that he was transported to san francisco general because they had a better treatment for people who experienced strokes and because

of that, my grandfather spent six additional months with us, and i think that that is really important, and those are the key factors that i am curious about. and you know, it is like a continuum of care and not just as one body, or you know, verses another, you know, like businesses, but as a continuum care of a person, living in san francisco how would i be taken care of? because my understanding is that if i had insurance and i can go to any of the hospitals, you know, that is separate from you know my primary care and you know that part should not be any consideration at all, but to really educate our residents about what they are entighted to and what kind of services they can actually access, and to improve the health so they can be a partnership in this and that is the part that i think that is missing for me. and you know then, two other things here.

that i have written down was the reason for all of these was really about the good faith. good faith that it is about trust. and i think that can be solved. you know, and i think that i have really comment on the health department staff and to really work with, you know, like cpmc to really work with you know, like the community groups, to look at how we can mitigate some of the concerns. and i am not hearing enough about how we hold ourselves accountable in this whole process. you know, like, you know, i appreciate people you know spoke prior to about where we think cpmc is in compliance and where they are not but also, it is not just the job for cpmc it is a job for all of us and so i think that you know it is also time for the master plan, you know it be revised and i think that that is the good opportunity to come in and do

some work, you know, like before we you know like we had to refer to the discussion, and so, i can't speak to whether they are really in compliance or not because as the health commissioners i don't think that we have the time of the jurisdictions to make any of that recommendations or you know like the demand binding. but i think that i am looking forward to next year. and you know like when we come back for this hearing, that, you know, at least you know what are some of the things that i will be looking for here. we are not just san francisco that has these number of hospitals, we have some on the cutting edge. we have been leading the way in healthcare, and reform and really have break throughs in how to treat the patients in this city and i think that is something that we should all be proud of and i have no doubt,

cpmc wants to be one of the partners that lead that way and so that happens, i think that is the what we need to continue to have conversations. >> thank you. >> commissioner moore? >> it is actually commissioner richards. >> great. >> i have a lot that i will get through it quickly. cpm is a community trust organization in my mind, and it is an asset to the city, and i certainly echo supervisor campos's sentiments on bringing everybody together here and i was a part of, you know, 2007, 2008 with the medical office, and all of the issues way up there. and i am concerned, and use davis all of the time and my doctor is a resident and i love them. i think that all being said, you know, i kind of reflect on what i am hearing here and i reflect through my private industry lens and i said that i manage billions of dollars over

my career and i have been a subject of audits and this is more or less an audit. >> facts are facts and you can't really get around the facts. we hear there were 6 people hired and there should have been 14 and the facts are the facts and i kind of come back and i say, you know, i look at this thing what is the value of this agreement and how many tens of millions of dollars are we looking at and how much in or how much are we that way, all the way there? are we 95, 97 percent, and like, we are almost there, right? and some of these items don't seem like they are big to me, there is a big one in me. and i think that a couple of thoughts and the smaller items and i am not sure why they are

happening, my husband is a nurse he has nothing to do with cpmc and, he is a dialysis nurse, and he does not speak chinese, but there are people that have, and they speak it on the staff and because they have the patients that come in and if you don't explain, they go come and they don't it right and come back and they have to go to the hospital and have a negative and will cost more in the out run, because they don't understand what they are doing. and i look at, diabetes clinic in the mission and if you don't speak spanish, you are kind of like behind the eight ball and you are not really being able to serve those patients and i kind of wonder why you would let the people go and not have the people speak spanish to a place where diabetes is ground zero and it is really the mission. we have the tax debate and the different things and this is really where the people and to be able to communicate to the patients, likewise in dave s.

and they all sort of have been let go and i any there are issues whether we think that the new case manager will be cultural proficient or competent and i look and i go, you know i kind of smell smoke here and i go, there must be something behind it and you might hide behind the fact that it is a personnel issue but i am seeing the data points and connecting them and going, it looks like a cost saving and there is something going on where you are letting people go that are doing a good job that have been there a long time. i am going to hold you accountable that. and i think, you know, i think that we need to face the facts and give ourselves an honest grade here. and if i run a private industry and you were auditing me i would get some sales, or whatever you know, their not in compliance, and a lot of compliances here so clearly there is a lot. but where we are not coming up to speed.

we should give ourselves and what is your mediation plan and i have the plans here today and we are doing this and that, and we have given money to the job training and we have adjusted how we are sending the clients over and all of these different things that you are doing. and tell us what you are doing and put it down in writing, and i think that you are going to get more public trust out tf and you are going to have more people respect the process and well on the way to making this work and i think that i respect the process a lot more, and i am almost done. the whole issue around the collateral agreements and i am torn on this one and i come from a background and i was on it, and one of the things that we demanded was that the community has to have an oversight and this is a grand plan for the cpmc, and i don't know exactly what the community involvement has been in you

know, how the monitoring is going here and i think that there should be some level, to the agreement and i don't know, i will wait to hear what the other commissioners think and that should be on the table at least for discussion and i think that lastly, to sum this all up, are we in compliance are not in compliance, i don't know. and the reason is, there is no form law for me to say if we get eight out of ten, that is a pass, if we get, you know, 94 out of 100 that is a pass and, there is no formula. and the one that bothers me, is the tender loin, if you put a gun to my head and we are going to audit you and we have to refer to the board of director's audit committee because you failed on one, it that one, i would say that we are not in compliance, thank you. >> thank you. >> commissioner antonini. >> thank you, and i want to

thank suter and cpmc for its investment in health in san francisco and jobs it is no small venture what you are doing in terms of bringing these resources that are very essential to our community up here. that said, i have an issue with treating matters that were brought up that i would like to address, regarding particularly serving the unserved communities in the tender loin. medical, issue, and the shortfall and also the saint lukes dialysis center and for me this is a health equity concern, i am not sure if they are three problems or one problem, and it is stranger than these are issues around under served care and, and i am not sure whether we have heard, the why, for example, there might be a difficulty arranging what we know and we know why there is no difficulty arranging services for the medical and the mso in the

tender loin and this is not one. and i am not sure that we heard why, there is a shortfall in the medical, out reach and char it able care services and i definitely did not hear why there might have been a staffing difference and how you might need the future needs of the patient serving, and for me, again, i just want to i am a lump era they are than a splitter, i would be interested to hear the reasons why from pmc, these decisions might have been made and particularly not only the why but what is the issue in terms of how you might resolve this? in terms of resolving this, i know that there has been conversations with the department of public health and i think that there are plans around each of these issues and my concern is that with each of these, there is also health equity and burdens that we have and these are under served communities and in serving these communities it is my

voice that we need to not only call out the issue but we need to go beyond and do the extra effort and so for example, the tender loin, sfo issue i think that we could wait, perhaps a long time before an mso comes into being but what if it does not, what do we do to meet the good faith effort of providing services in the tender loin if it does not and how can they make that pro-active effort to be involved, the same thing with the medical shortfall, again i would like to know why and how we can solve that and lastly, with regards to the diabetes center, my understanding is that it probably would not be until we have a set of patient complaints of lack of services or the delay of services that the issue might come forward and so before that happens, again, we would really encourage pcmc to do the good work that you have known that you have been doing in the community to take our pro-active stance and to do the

extra effort to address the reasons why, find out what they are to drill down and then perhaps come forward at the next time with plans to share with us, this is what we think is the issue, and this is what we are going to do and get ahead of the curve and not have to follow behind the ball that said, you know, i am happy that our staff is recommended in terms of compliance but i just want to make sure that there is also good faith effort to meet the spirit of the agreement. >> thank you. >> thank you. >> commissioner sanchez? >> i would just like to thank everybody for coming out this morning, and sharing with us, your dialogue and your concerns and pertaining to this unique collaboration. which is now been under way and which has some unique challenges, which were brought out by our staff and also, emphasized and highlighted by a